What is thrombendarteriectomy?A thrombendarterectomy refers to various surgical procedures for the removal of a blood clot or clot (thrombus) and the restoration of blood vessel function after constriction or occlusion.
Literally, thrombendarteriectomy (TEA) is the removal of a thrombus, a blood clot or blood plug, that has become lodged in an artery and has caused a stenosis or complete occlusion of the artery. Since the thrombus is usually connected to the vessel walls, the inner epithelium, the inner epithelium of the affected artery is usually removed as well.
In order to restore the function and load capacity of the artery after the removal of the thrombus, various techniques of restabilization are available. The affected vessel walls can be resealed and stabilized with an endogenous material from a vein wall or plastic patches are used as so-called patch plastics. As a rule, a TEA is used to eliminate stenosis of the internal carotid artery and to treat peripheral arterial disease (PAOD). PAOD is also known as intermittent claudication or smoker's disease because heavy smoking significantly increases the risk of disease.
Function, effect & goals
An arterial constriction or occlusion not only can severely affect the body region that needs to supply the artery with blood, but there is also a risk that the thrombus or parts of it dissolve and be transported with the bloodstream to other parts of the body, where a new arterial stenosis or a closure can form. If one of the cervical arteries is affected, there is an acute risk of a clot sticking in the brain and causing a stroke because of an acute undersupply of oxygen and other essential substances in the affected nerve areas.
The two most common uses of TEA are carotid stenosis and the treatment of peripheral arterial disease, which mainly affects the legs. Less common applications are the treatment of mesenteric artery stenosis, which can lead to a bowel infarction with serious effects. Also less common is the treatment of stenosis of the right and left pulmonary artery, the pulmonary artery via TEA.
For the implementation of a TEA four different surgical methods are available depending on the diagnosis. These are the Patch Technique, the Eversion Technique (EEV), the direct fastener and the fork transposition. The patch technique is used when parts of the inner vessel epithelium have to be replaced.
If possible, the patch is made from the vascular wall of a body's own vein, or plastic patches made specifically for this purpose are used. If the conditions on the vessel walls of the opened artery after TEA allow, the open vessel walls are sewn with a continuous distance seam in the so-called Parachute technique. It is usually used a resorbable by the body tissue thread. The advantage of the direct closure is that no patch from an endogenous vein must be made. However, there is little danger that the artery will be narrowed (stenosed) postoperatively.
Eversional Technique (EEV) is a modern technique used mainly in carotids narrowed by more than 50%. After clamping the internal carotid artery, the inner branch is severed directly on the carotid fork and uncovered and everted by everting the vessel walls of the plaque cylinder. The free end of the carotid twig is then re-sutured using the Parachute technique without the use of any plastic patches or patches. Especially for patients who have already experienced a so-called striation, short-term symptoms of a stroke, such an intervention can effectively prevent a threatening stroke.
Risks, side effects & dangers
In addition to the risks of infection or even infection with multidrug-resistant hospital germs in all open surgeries, TEA interventions - especially the opening of carotids - carry specific risks. Since the internal carotid artery to be treated is clamped immediately before the procedure, the blood flow is interrupted and the brain regions to be supplied with oxygen and energy must be constantly checked for proper functioning.
The procedure is usually performed under local anesthesia, so that the patient is constantly entrusted with small motor and logical tasks. There is also a risk of tiny micro-thrombi loosening, lodging in the brain, and causing a stroke during the procedure. Especially with heavily calcified arteries, including arteries of the extremities, there is a risk that the vessel walls will rupture during the removal of the plaques due to the intimate connection between the plaques and the epithelia of the arteries and require special restructuring measures.
Especially in the treatment of carotids there is a fundamental risk that adjacent structures are injured during the procedure. Unintentional lesions of certain nerves, such as the vagus nerve, may in extreme cases disturb the swallowing reflex and voice. A TEA also does not reliably rule out a recurrence in the form of a rethrombosis, which usually manifests itself within a few days. After the removal of the inner epithelium of the treated artery, it regenerates within a few days (neointima). For prevention, therefore, the use of anticoagulant drugs (anticoagulants) is recommended.